As known, the laryngoscope is an instrument used in particular by a physician in order to visualize the glottis (that is usually impossible to see) and the vocal cords. It basically comprises two parts: the handle, where a set of batteries are installed inside; and the blade, that is the part inserted inside the mouth of a patient, and that further includes a small light bulb being able to enlight the inner part of the larynx. The laryngoscope is an essential instrument for endotracheal intubation of a patient, and that means everytime it is required a direct connection of the air tracts with instruments able to support the ventilation. In order to obtain this result, normally a flexible tube is inserted, the so called endotracheal tube, that is gradually pushed inside the air tracts, beyond the epiglottis and the vocal cords, until it reaches the first tract of trachea with an extremity, while the other extremity is kept outside of the patient, in order to connect, i.e., a machine able to support ventilation.
In this procedure it is very important that said inner extremity reaches the proper position, and that is not sent by mistake to the esophagus, causing consequent huge problems to the patient. Further, intubation is a very critical procedure, because important anatomical parts are touched, like i.e. the vocal cords, that absolutely should not be hurt by passage of the above instruments. Furthermore, usually this procedure must be done as fast as possible, in order to guarantee a proper ventilation of the patient.Another important point is that glottic and paraglottic structures are not easy to be visualized, sometimes a physician should follow the procedure without a complete view of these structures, i.e. because of the specific anatomy of some patients, or because of specific situations, like i.e. seriously injured people, where the head and cervical part of vertebral column are required to be blocked, in such a way that specific actions of physicians (like i.e. extension of the atlanto-occipital joint while bending forward the lower tract of the cervical column) are difficult, these actions are usually done in order to have a more effective laryngoscopy, using a laryngoscope, before to place an endotracheal tube. Furthermore, the above situations can occur simultaneously, or one can be more relevant than others, up to extreme situations, like i.e. in a emergency where a physician cannot visualize any glottic structures, and it is necessary to operate almost in a blindness situation, placing the laryngoscope and the endotracheal tube trusting more in personal experience and ability, than in a direct view of such structures.Again, considering a possibility, absolutely not remote in a seriously injured patient, of a huge bleeding in the upper air tracts or immediately adjacent structures, where a hematic diffusion occurs in glottic and paraglottic parts, then the situation of a low or null view of these anatomical structures brings to a condition of relative useless for advanced and modern technologies like i.e. that based on optical devices (fiberscopes and video-laryngoscopes). At this point, the physician has the only choice, before to start techniques of tracheostomy in a emergency, of going for an attempt of blind intubation, using one of the well known techniques for these situations (fast track, track light, both laryngoscope and tube-stylet devices).Actually, one of the best known intubation techniques is based on the so called stylet, which is a rigid metallic wire, fixed inside an endotracheal tube. This endotracheal tube, with the above said stylet fixed inside, can be properly shaped by a physician, and then inserted, with the visual help of a laryngoscope, inside the mouth of a patient, pushing the extremity towards the trachea. This procedure could require a certain number of different attempts by medical staff, and each time the proper position of the endotracheal tube should be verified, eventually extracting and inserting it again and again, until the profile is compatible with the air tracts of the patient.Naturally, each of the above attempts increases the possibility of hurting some important tissues, like i.e. the vocal cords, and it makes the intubation procedure very hard and difficult for medical staff. This procedure requires at least the simultaneous action of two doctors, where the first applies the laryngoscope, in order to see and follow the best direction for the endotracheal tube, while the second is responsible for removing the stylet at the end of operations.Thus, both the multiple attempts and the need for two doctors, that should coordinate their respective actions, increase the final execution time for this procedure, and increase the consequent possibility of direct or indirect complications for the same patient.
In the prior art, the problem of finding a new method, or medical device, suitable to improve the actual endotracheal intubation of a patient, is particularly known and important. Some solutions have been proposed in order to obtain an indirect guide, based on outer magnets, and giving the possibility of installing an endotracheal tube in the proper place.
For example, U.S. Pat. No. 4,063,561 describes an outer magnet, able to interact with the lower extremity of an endotracheal tube, during the process of patient intubation. This magnet is especially useful in order to avoid a wrong direction towards the esophagus. In U.S. Pat. No. 4,244,362 a similar solution is described, where a stylet is inserted inside an endotracheal tube, that is placed along the air tracts of a patient. At the extremity of the same stylet it is placed an inner magnetic element, so that it can interact with an outer magnetic element. This stylet presents a profile able to shape an endotracheal tube, in order to provide a proper intubation of the same patient.U.S. Pat. No. 4,244,362 describes a system useful to define the proper direction of an endotracheal tube during the operations of patient intubation. It comprises a flexible stylet with a first magnet, placed at its own extremity, and an outer structure, similar to a collar, with a second magnet placed close to the crico-thyroid membrane. The alignment of magnets guides the stylet towards the best direction, and permits to insert the endotracheal tube in the proper position.
Again, in order to improve the actual procedures of patient intubation, some other solutions are known where the laryngoscopes have a specific variable blade's profile, that is particularly useful to move inner tissues of the patient. In example, the so called McCoy laryngoscope has an original mechanism, as described in U.S. Pat. No. 4,573,451, where the remote extremity of the blade can be rotated up, using a specific lever placed behind the handle.
All these known solutions have a certain number of drawbacks, in example:
                the inner magnetic element is placed on a specific element, that is a stylet, and it must be removed in order to leave the endotracheal tube alone; this step where the stylet is removed and then inserted again, increases the execution time of the complete procedure, and increases the risk of hurting inner tissues of the patient;        the outer magnetic element is placed close to the crico-thyroid membrane, that is a good point to indicate the final position of an endotracheal tube, but it does not give any advantage to physicians, with reference to the problem of reaching the same point, through tissues that can obstruct the air tracts of the patient;        the use of a certain number of instruments, that are a laryngoscope, an endotracheal tube, a stylet and an outer magnet, requires the coordination of at least two doctors, with consequent difficulty for the operations of intubation;        the outer magnetic element represents a reference point for positioning the tube towards the trachea, but it does not avoid the problem of reaching that point, that requires a certain number of attempts, where the endotracheal tube, with the stylet inside, is removed and inserted again and again, until the profile is perfect in respect of the air tracts of the patient.All these drawbacks are critical for the ideal characteristics of an endotracheal intubation procedure, that should be fast, precise and effective, without damage or side effects for the patient.        